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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- ---------------- ---- (Complete in Triplicate) Permit No. -Z _-__-- This Permit Expires I Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _A-4-1p -�- .G-A R701V--------1,--AAro-A---------------------------------CENSUS TRACT Owner's Name ---------22 35- --------5 m I- Bp, `�E- = �<S cAl-ci � Phone .�&-2_L17 Address ----IV.- �'a----`5--------e*- �_/)t`-------------------- --------------_--. City --------- _ Contractor's Name ._- -C d-Gz_�_ }11 erase # _sf_ .____ Phone 3__ _ __��0.e__ ----------/yOMA-_'Z-----'G_Pa� /_o T- Installation will serve: Residence ❑Apartment House Commercial []Trailer Court M Motel ❑Other WORKS N©-r-----.RIF- -7-ROOM Number of living units_____________ Number of bedrooms .-----------Garbage Grinder ------------ Lot Size ___ REr4 - -----_______ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private [ Character of soil to a depth of 3 feet: Sand 2k Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-❑ Fill Material _ 12__`tf yes,type __._______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [1(] SEPTIC TANK f ] Size---_2'___`__? ------------------------------ Liquid Depth ---�Y------------------ �1 Capacity - - ------- Type 4 A/M ' Material---------------------- No. Compartments ----�"----:__-- Distance to nearest: Well ----Z-.Q-0_f-----------------Foundation ---------------------- Prop. Line .-----------._.-_._-_- �_ ______ Length of each line. LEACHING LINE [ No. of Lines ___________ __ __ _--___._-_.-- Total Length _3_______..-______________ D' Box __--_t-___ Type Filter Material __a______._ h-Depth Filter Material ____f,d._________________________________ Distance to nearest: Well -__�_0-0_ ------ Foundation -�_�.J------------ Property Line ________________________ SEEPAGE PIT [ ) Depth -------------------- Diameter ------- ------- Number -------- ------------------- Rock Filled Yes ❑ No 0 Water Table Depth ----------------------------- --------------------- ---------------------Rock Size ------------ ------------------- n Distance to nearest: Well ----------------- ----------------------Foundation -------------------- Prop. Line _-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ ----------- ------ Date -----------------..---------------) Septic Tank (Specify Requirements) -------------------------------- --------------------------------•--------------------------;------------ Disposal Field (Specify Requirements) ___`TQ__---.-R -�F}CE -_-_- �C�STiIET [�-_--']' }N . -INA D19�---�-F4- ---- Fr_��.b-`--i*+ -------JDO----- - - ----- of (z� Rr 4sr. �I`14' O2 ` cfi- ._ r- -------------------------------------------------------------------------------------------------------•-------------- (Draw existing and required addition on reverse side) I hereby certify that .1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------- ------ Owner BY {+ --------------------------------------------------------------------- Title _-Vi-C�7 ------------------------------------------------ (I other than owners FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------�'[-R-0-------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED ----------- ---------------------------------------------------- --- - ------------- --- ---DATE ------------------------------------------- ADDITIONAL COMMENTS ---------- -- ------------ ---- - --------------------------------------------- --------------------------- -- -------------- i --------------------- ---- -- --- - -- - -- ------------------------------------------------ � - ---- - - ------- - -- --- ns lnspe b Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M